Source:

Lupu DE, et al. Am Jrnl of Kidney Diseases. 2021;doi:https://doi.org/10.1053/j.ajkd.2021.08.019.



Disclosures: Lupu reports no relevant financial disclosures. Funding for the study was provided by Donaghue Foundation Greater Value Portfolio. Please see the study for all other authors’ relevant financial disclosures.

October 18, 2021
2 min read
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Individualized coaching may help patients with CKD who need advanced care planning

Source:

Lupu DE, et al. Am Jrnl of Kidney Diseases. 2021;doi:https://doi.org/10.1053/j.ajkd.2021.08.019.



Disclosures: Lupu reports no relevant financial disclosures. Funding for the study was provided by Donaghue Foundation Greater Value Portfolio. Please see the study for all other authors’ relevant financial disclosures.

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Individualized coaching may be effective in enhancing advanced care planning for patients with chronic kidney disease, but delivery of the information is the key to success, a recently published study shows.

“Although guidelines recommend more and earlier advance care planning (ACP) for patients with chronic kidney disease (CKD), scant evidence exists to guide incorporation of ACP into clinical practice for patients not yet requiring maintenance dialysis,” Dale E. Lupu, PhD, MPH, and colleagues wrote in the American Journal of Kidney Diseases. “Involving nephrology team members in addition to primary care providers in this important patient-centered process may increase its accessibility.”

Lupu is a member of the faculty at the George Washington (GW) School of Nursing and holds adjunct appointments at GW's Milken School of Public Health and the Bloomberg School of Public Health at Johns Hopkins University.

The researchers developed an intervention for the study that integrated ACP into the CKD clinic setting. “This project aims to meet patient desires for ACP before initiating dialysis. The intervention, called ‘Make your wishes about you – MY WAY,’ employs in-person coaching aligned with evidence indicating that in-person methods are consistently effective,” they wrote.

MY WAY coaching is based on “motivational interviewing, providing a patient-centered approach responsive to various patient experiences and preexisting levels of engagement,” the researchers wrote.

Study group

The non-blinded, randomized clinical trial compared in-person ACP coaching vs. patients receiving educational material to review on their own, called enhanced usual care. “Primary outcomes were participant engagement in ACP and documentation in the CKD clinic medical record. We hypothesized that both engagement and documentation would increase more in the coaching arm than in the enhanced usual care arm,” Lupu and colleagues wrote.

Three clinics in different states participated in the study. Eligible patients had stage 3 to 5 CKD, were 55 years or older and spoke English. Of the group evaluated for the study, 273 patients consented to participate and 254 were part of the analysis.

Intervention

Individual sessions on ACP were administered by nurses or social workers with experience in nephrology or palliative care. This patient group, called the enhanced control group, was given the MY Way education materials and was “verbally encouraged to bring their completed advance directives to the clinic.” Lupu and colleagues developed primary outcome measures scored on a 45-point ACP engagement scale at 14 weeks and an advance directive or portable medical order at 16 weeks after enrollment.

Of the 254 patients analyzed in the study, 46.5% were 65 to 74 years old and 54% had CKD stage 3.

Patients who were coached scored 1.9 points higher at 14 weeks on the ACP engagement scale. “Overall, 32.8% of intervention patients had an advance directive compared to 17.8% (23 of 129) of patients in the comparison group. In a site-adjusted multivariable model, coached patients were 79% more likely to have a documented advance directive or portable medical order,” the researchers wrote.

“Individualized coaching may be effective in enhancing ACP but its impact may be influenced by the health care environment where it is delivered,” Lupu and colleagues concluded.